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Vol <br /> SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180 . 7 <br /> A. EMERGENCY LEVELS I III PHS-EH LOG # <br /> ( ircle One) <br /> B . SOURCE OF INFORMATION Phone: <br /> Name: See'SI-F' � 5 g2 N <br /> Company: RelN G See <br /> Address : I Sri` <br /> Designated Employee Nae: Lc- Poe: <br /> m ` y6�= 3 OZO <br /> Reporting Agency Name: i✓ c Rs <br /> Address : P o -C 1'001 09 <br /> Co LOCATION AND DATE OF DISCiAI�GE <br /> Location: <br /> / � � 7 5 �` ��� +/ / (qty or County) Circle One <br /> (Best Physic9l Description) <br /> Date of Discharge: � <br /> Date Notified: �/'" — `/� Time: <br /> D . RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: /� eS T/aiI �4 G-- <br /> Contact Person: Y B 5 Telephone: <br /> Physical Address / S ��sl jo <br /> Mailing Address: 00 <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: q✓ <br /> Chemicals : /b ✓ o n.r <br /> f. Circumstances : S'� 'L �" %J ?i S LAI <br /> 2 S �✓2 �� v <br /> F . ACTION TAKEN <br /> v <br /> SITE DISPOSITION <br /> M � � <br /> /tee a <br /> SIS <br /> � M T <br /> I <br /> EH 22 013 (Rev. 4/91 ) <br />